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Abstract

Background: The influence of renal disease on outcomes of patients with STEMI undergoing primary PCI is understudied. We evaluated patient characteristics and outcomes according to different degrees of renal failure using data from APEX-AMI.

Methods: Glomerular filtration rate (GFR, mL/min/1.73m2) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and subjects were categorized according to stages of CKD by GFR (dialysis dependent, ≤ 30, 30-60, 60-90, >90). Demographics, time to presentation, angiographic results, and clinical outcomes were examined for each category of renal disease. Using a multivariable adjusted model, the association between GFR and the pre-specified adjudicated 90-d endpoint of death, shock, or heart failure was determined.

Results: A total of 4,897 patients were included, of which 23.7% (1,161) had ≥ stage 3 CKD. Those with worse renal function were more likely to be older, female, present in shock, have delays to PCI, and have complications of atrial fibrillation, severe bleeding, or infection (Table). Despite a similar distribution of pre-intervention TIMI flow grades, post-intervention angiographic outcomes were significantly worse with increasing degrees of renal failure. Lower GFR was also significantly associated with higher 90-d death/shock/heart failure (adjusted HR = 1.17; 95%CI: 1.10-1.23, per 10 unit decrease in GRF).

Conclusions: In STEMI patients undergoing primary PCI, worse degrees of renal failure were associated with delays to PCI, worse angiographic outcomes, and increased 90-d death, shock or heart failure. This high risk subset of a broadly inclusive population, with approximately one-quarter having a GFR < 60, constitutes a major unmet need deserving further attention.